Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial.

Autor: Piardi DS; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Butzke M; Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil., Mazzuca ACM; Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil., Gomes BS; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Alves SG; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Kotzian BJ; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Ghisleni EC; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Giaretta V; Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil., Bellaver P; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil., Varaschin GA; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Garbin AP; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Beck-da-Silva L; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. lbneto@hcpa.edu.br.; Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil. lbneto@hcpa.edu.br.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2021 Aug 13; Vol. 11 (1), pp. 16474. Date of Electronic Publication: 2021 Aug 13.
DOI: 10.1038/s41598-021-96002-6
Abstrakt: Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Fifty-one patients were randomized-26 to the HCTZ group and 25 to the placebo group. There was an increment of 0.73 kg/day towards additional weight reduction in the HCTZ group (HCTZ: - 1.78 ± 1.08 kg/day vs placebo: - 1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: - 0.74 ± 0.47 kg/40 mg vs placebo: - 0.33 ± 0.80 kg/40 mg; p = 0.032). There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes. Adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure did not cause significant difference in daily body weight reduction compared to placebo. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a significant synergistic effect on weight loss.Trial registration: The Brazilian Clinical Trials Registry (ReBEC), a publically accessible primary register that participates in the World Health Organization International Clinical Trial Registry Platform; number RBR-5qkn8h. Registered in 23/07/2019 (retrospectively), http://www.ensaiosclinicos.gov.br/rg/RBR-5qkn8h/ .
(© 2021. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje